Phone Monitoring That Cut Miamidade Medicaid Fraud May Expand

By Patricia Hoyos
A pilot telephone monitoring program aimed at cutting Medicaid fraud in Miami-Dade County has helped cut expenditures for home health visits, and now the Agency for Health Care Administration aims to expand the program to more counties.

According to the agency, 201 Miami-Dade providers were reimbursed $21,628,538 in fiscal 2010-2011 after the program was introduced, while in fiscal 2009-2010, 253 Miami-Dade providers were reimbursed $43,285,931 for home health visits.

Agency officials anticipate that expanding the project to other Florida counties may lead to greater savings — an estimated 10% of current reimbursements — in Medicaid expenditures for home visits, said Michelle Dahnke, communications director for the Agency for Health Care Administration, via e-mail.

The agency began the Telephonic Home Health Services Delivery Monitoring and Verification Project in Miami-Dade on July 1, 2010, with Sandata Technologies, a New York-based company, operating the program.

On Feb. 1, the agency sent an evaluation of the project to the governor, president of the Senate and speaker of the House, requesting authority to expand the program to other counties. Florida agencies can submit legislative budget requests for consideration by the legislature during its annual session.

The agency submitted the request as part of its budget request for fiscal 2012-2013, which begins next July 1. The next legislative session to set policy and budget is to begin Jan. 10, running through March 9, Ms. Dahnke said.

While the program is working as planned, it isn’t fully responsible for the decreased expenditures. According to the report, the agency was already having success in monitoring home health visits in 2009 before the program began, partly because of the agency’s onsite reviews of home health agencies in Miami-Dade and strict enforcement of the prior authorization requirements for such visits.

Medicaid expenditures in the county for home health visits have fallen 35% since fiscal 2006-2007, saving the state over $23 million, the report stated.

The technology uses voice recognition to verify that home health care workers who serve Medicaid patients actually visited those patients. It requires health providers to submit claims for home health systems electronically through Sandata’s system. At the beginning and end of a visit, the firm gets calls from the health care worker to validate their authenticity.

While the phone monitoring program was begun in Miami-Dade as a way to cut Medicaid fraud, Harold Blue, CEO and vice chairman of Sandata, said that, for most states across the nation using the technology, reducing fraud isn’t the main purpose

"Medicaid fraud is one part of it," he said. "No. 1 is to make sure that people are being taken care of."

According to the report, the program has allowed the agency to collect data regarding the visits it had no access to before, including when there were missed or late visits, the length of each visit and information on the specific person providing the visit.To read the entire issue of Miami Today online, subscribe to e -Miami Today, an exact digital replica of the printed edition.